| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,756 |
2,655 |
$97K |
| D1120 |
Prophylaxis - child |
3,550 |
2,988 |
$74K |
| D1351 |
Sealant - per tooth |
2,869 |
754 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
641 |
402 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
821 |
492 |
$50K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
209 |
142 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,647 |
1,988 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,901 |
1,512 |
$24K |
| D0330 |
Panoramic radiographic image |
786 |
722 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,705 |
1,572 |
$17K |
| D1206 |
Topical application of fluoride varnish |
758 |
743 |
$16K |
| D0274 |
Bitewings - four radiographic images |
868 |
708 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
210 |
210 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
337 |
333 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,297 |
1,201 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
252 |
232 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
876 |
365 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
28 |
$3K |